By Shannon Brownlee
Washington MonthlySometime in the late '80s, the CEO of the drug company Glaxo-SmithKline realized he had a problem. Glaxo's lead drug at the time was Zantac, which accounted for one-third of the company's bottom line and was also the world's bestselling ulcer medicine. Zantac had to stay the world's bestselling ulcer medicine for another few years while Glaxo scientists searched for replacements because the drug was slated to lose its patent protection in 1997.
The problem was, evidence had been accumulating for several years suggesting that ulcers are not caused by an excess of stomach acid, which Zantac was really good at suppressing, but rather by a bacterium known as Helicobacter pylori. "The implication, hopeful for patients," as author Greg Critser puts it, "was also dismal for Glaxo." Scientists from Glaxo and other companies pooh-poohed the bacterial theory, but by the early 1990s, clinical trials had shown that antibiotics could, in fact, effectively clear up ulcers, leaving Glaxo and Zantac in search of a new market.
The company's salvation lay just north of the stomach, with the condition Gastroesophageal Reflux Disease, or GERD. GERD occurs when the esophageal sphincter, the ring of muscle at the top of the stomach, allows acid to creep up the esophagus. Basically, GERD is chronic heartburn--heart-burn so bad it can eventually damage the cells lining the esophagus. Zantac was great at treating GERD, too, but there was just one problem: GERD isn't common. Heartburn, on the other hand, is; but, unfortunately for Glaxo, most people considered heartburn nothing more than one of the wages of overindulgence, treatable with an over-the-counter remedy or a little more self-control at the dinner table--not with a prescription drug.
What Glaxo needed to do was persuade people that ordinary heartburn was an early-warning sign of GERD.So, Glaxo and its marketing team set about popularizing GERD and its potentially dire consequences through a marketing technique that is now used routinely by drug makers, and which came to be known as "condition branding," or selling a disease along with a drug. To brand GERD, Glaxo launched a public relations campaign called "Heartburn Across America."
The campaign used the graphic of an erupting volcano to illustrate to consumers the severity of GERD. The company also set up the Glaxo Institute for Digestive Health, which funded research as a way to reach out to physicians. It enlisted the help of the American College of Gastroenterology, the professional organization for doctors who specialize in treating diseases of the stomach and gut, a campaign that deliberately and effectively conflated GERD, which is serious, and heartburn, which is not, in the minds of both consumers and doctors.
The rest, as they say, is history. Zantac sales skyrocketed, hitting $2 billion a year at its peak, two-thirds of which was for GERD. Physicians began to view Glaxo as a leader in the field of gastroenterology; consumers started worrying that their heartburn was potentially dangerous. Condition branding was soon being used by other drug makers to sell everything from high-cholesterol medications to Viagra.
And, as writer Greg Critser argues in this fascinating, often funny but ultimately flawed book, the drug industry's brilliant marketing techniques also helped turn Americans into a nation of pill poppers, or "Generation Rx." The book's first half is devoted to a detailed and compellingly told history of the transformation of the pharmaceutical industry from a group of conservative companies, focused on research and development, into marketing powerhouses. Drawing on his decade as a pharmaceutical business reporter, Critser, who is also the author of Fatland: How Americans Became the Fattest People in the World, chronicles the rise of DTC, or direct to consumer advertising.
Before the 1980s, the idea of advertising directly to consumers seemed unethical to most drug companies, an attitude that was on display in a remarkable set of letters written to Congress in 1982 by pharmaceutical executives. In one letter, Charles Hagan, vice president and general counsel of American Home Products, wrote, "[Direct to consumer] advertising would make [patients] extraordinarily susceptible to product promises." The head of Smith, Kline & French wrote that "advertising would have the objective of driving patients to their doctors' office," while the head of Abbott Laboratories worried that advertising to consumers would lead them to pressure their doctors to prescribe drugs "that may not be needed."
Drug company executives would change their minds about DTC advertising over the course of the 1980s and 1990s, once a few maverick marketers used DTC ads to drive up sales. A series of Supreme Court cases, brought by consumer groups and the advertising industry, eroded the boundary between commercial speech and individual free speech, and forced the Food and Drug Administration, which oversees drug industry marketing, to change its rules. New, liberalized regulations issued in 1997 sent drug sales through the roof, ironically bringing about many of the pharmaceutical executives' predictions.
The industry now spends on the order of $3 billion on DTC advertising, and sees $4.20 in return on every dollar invested in "driving patients to their doctors' offices." The result has been rapidly rising pharmaceutical drug use. In 1993, the average number of prescriptions filled per person per year was seven. In 2000, it was 11; it was 12 four years later. Some 27 percent of elderly Americans are on nine or more medications simultaneously, compared with 17 percent in 1997.
Linkback:
https://tubagbohol.mikeligalig.com/index.php?topic=3537.0
